Individual medical coverage offers reimbursement for health care. Prescription assistance programs may be included in some programs. Several programs may well provide for payment of health charges incurred on a reimbursement basis by paying benefits to the policy owner, payment on a service basis by paying those who provide the services directly, or payment of an indemnity by paying a prearranged amount regardless of the sum charged for health bills. Health expense or hospitalization coverage may perhaps be issued on an individual or group basis. A few of these plans will provide prescription help.
Even though there are several types of benefits to be had, private health expense coverage can commonly be categorized as basic health expense coverage, major medical insurance, comprehensive medical coverage, and special programs. These plans should cover prescriptions because prescription drugs help so many people. Nearly all of these policies have by and large been replaced by managed care policies and are no longer offered as stand-alone policies. These types of policies have been adapted and replaced in answer to changes in the health care field relative to cost control and market competition.
Basic coverage provided by a personal medical expense policy includes hospital expense, surgical expense and medical expense. These three basics might be issued as one or individually. Often this is issued as “first dollar” coverage, which means it does not contain a deductible.
As the name indicates, hospital expense insurance provides benefits for visits incurred for the period of hospitalization. Hospital indemnities are commonly classified into two general groups:
• Room and board, as well as nursing care and special diets
• Miscellaneous health charges, including x-rays, laboratory fees, prescription medicine, medical supplies, and operating and treatment rooms
In a number of cases, surgical benefits possibly will be included for several types of surgery and related expenses. Hospital expense insurance provides benefits for daily hospital room and board and various hospital charges whilst the insured person is confined to the hospital. The policy may possibly provide for a specific dollar amount for the daily hospital room and board benefit, even though the trend is in the direction of insurance of not more than the semiprivate room charge unless a private room is medically necessary. The room and board benefit might be paid on either an indemnity basis or a reimbursement basis, depending on the specific plan.
Indemnity policies are sometimes called dollar amount plans. Room and board rates change by geographic location, but it is not unusual to find room and board rates ranging from $350 to $850 per day or more.
Usually, the maximum number of days is from 3 to 400 . More frequently, room and board expenses are paid on a reimbursement basis. also called an expenses incurred basis~This is commonly called a expenses incurred basis~This is frequently called a expenses incurred basis}. Under this agreement, the policy will reimburse in one of two methods.
• The actual expenses for a semiprivate room are covered.
• A percentage of the actual charge is paid, with no specific dollar limit.
Under the first reimbursement option, the health insurance company will pay the full actual semiprivate room rate, regardless of what it is. Under the second reimbursement option, the insurance company pays a specific percentage, regardless of what the actual charges are. A common percentage is 80%.
To summarize, under the actual expenses kind of reimbursement plan, the plan will pay the actual amount charged for a semiprivate room with no regard to a specific dollar limit. Under the percentage type of reimbursement insurance, the plan may pay a specified percentage of the actual bill.
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